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Introduction Diabetes is one of the main pandemics in recent years. Its association with depression increases the risk of mortality and morbidity. The coexistence of both diseases leads to poor management of diabetes, which leads to a worse quality of life. Objective To determine the frequency of depression in patients with diabetes mellitus and the effect of both pathologies on the quality of life in patients who attend outpatient appointments at public health facilities in Lima and Callao. Methodology Secondary analysis of the Epidemiological Study of Mental Health of depression in diabetic adults. The instrument used to determine the depressive episode was the MINI (Mini-International Neuropsychiatric Interview) while quality of life was measured using the Mezzich Quality of Life Index. Diagnosis information of type 1 or 2 diabetes was obtained from the daily medical record (HIS) of care. Results The frequency of depression in the 471 patients with diabetes was 5.8% in the last two weeks. While the annual frequency was 8.6% and 31.8% at some point in life. Being a woman was associated with a greater frequency of depression. Quality of life was lower in patients with diabetes and depression (p Conclusions The frequency of depression in patients with diabetes who are treated on an outpatient basis in public health centres is higher than the general population and their quality of life is significantly reduced, which raises the need for considering depression as an additional factor to the burden of morbidity of this condition.

Introduction: Brain metastases (BM) in soft-tissue sarcomas (STS) is associated with poor prognosis. This large population analysis presents (1) demographic and clinical variables of these patients, (2) potential risk factors, (3) impact of BM on overall survival, and (4) treatment strategies. Methods: Patients with STS and BM were identified from the Surveillance, Epidemiology, and End Results database. Demographic and clinical variables, as well as treatment modalities, were analyzed. Overall 5-year survival was calculated using the Kaplan-Meier method, and the survival difference was assessed using the log-rank test. A multivariate analysis was performed using the Cox proportional hazard regression to determine the risk factors. Results: Twenty-two patients (22/8,433) with STS presented BM at diagnosis. A multivariate analysis showed that women and American Indians/Alaska Natives had a greater risk of presenting BM. The most common histological subtype to metastasize to the brain was alveolar soft part sarcoma (4/22). In 54.5% of patients with BM, the tumor had also metastasized to the lung, although having synchronous bone, liver, and lung metastases showed the greatest increase in risk for presenting BM (odd ratio [OR] = 1,857.7, confidence interval [CI] 95%, 88.4 to 3,9046.6, P < 0.0001). Individually, bone metastasis increased the risk of presenting BM the most (OR = 205.0, CI 95%, 30.5 to 1,379.6, P < 0.0001). The mean survival of patients with BM was 10.22 months. The standard treatment approach included surgery, radiation therapy, and chemotherapy. Conclusion: BM in patients with STS represents an infrequent but lethal event. Women and American Indians/Alaska Natives are at a higher risk of presenting BM, as well as patients with synchronous metastases. Patients are mainly managed with systemic therapy.

Objectives: To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents. Methods: A multicentre, observational, and prospective analytical study was conducted on the sedation-analgesia procedure performed on children younger than 18 years old in 18 paediatric emergency departments in Spain from February 2015 until January 2016. Results: A total of 658 procedures were recorded. The effectiveness was good in 483 cases (76.1%; 95% CI: 72.7–79.4%), partial in 138 (21.7%; 95% CI: 18.5–24.9%), and poor in 14 (2.2%; 95% CI: 1.1–3.4). The effectiveness was better when the doctor in charge was an emergency paediatrician (OR: 3.14; 95% CI: 1.10–8.95), and when a deeper level of sedation was achieved (OR: 2.37; 95% CI: 1.68–3.35). Fifty two children (8.4%) developed adverse drug reactions, more usually gastrointestinal, neurological or respiratory ones (89.9% were resolved in

The main objective of this research is to determine the psychosocial differences between patients with knee pain or early osteoarthritis (EOA) and healthy subjects at risk of developing osteoarthritis. The secondary objective is to determine how psychosocial factors might influence pain and social participation in patients with EOA. A cross-sectional study was performed. Participants were divided according to the presence of pain or EOA. Pain intensity both at rest and walking, psychological variables such as anxiety and depression, and social participation were evaluated. A total of 105 participants were included (64 with knee pain and 41 without pain), with a mean age of 51.42 ± 5.92 (35 men and 70 women). Patients with knee pain had higher levels of anxiety (MD = −2.35, p &lt, 0.01, d = 0.66) and depression (MD = −2.45, d = 0.87), regardless of the presence of EOA. In addition, patients with higher depression levels had lower levels of social participation. The results revealed a relationship between the psychological variables, anxiety and depression, with knee pain and the onset of symptomatic OA, as well as an influence of depression levels on social participation. Improving these psychological characteristics may be useful in delaying the onset of symptomatic OA and enhancing social participation.

Aims The objective of this study is to analyze how the impact of Diabetes Mellitus [DM] in patients with COVID-19 varies according to altitudinal gradient. Methods We obtained 1,280,806 records from adult patients with COVID-19 and DM to analyze the probability of COVID-19, development of COVID-19 pneumonia, hospitalization, intubation, admission to the Intensive Care Unit [ICU] and case-fatality rates [CFR]. Variables were controlled by age, sex and altitude of residence to calculate adjusted prevalence and prevalence ratios. Results Patients with DM had a 21.8% higher prevalence of COVID-19 and an additional 120.2% higher prevalence of COVID-19 pneumonia. The adjusted prevalence was also higher for these outcomes as well as for hospitalization, intubation and ICU admission. COVID-19 and pneumonia patients with DM had a 97.0% and 19.4% higher CFR, respectively. With increasing altitudes, the probability of being a confirmed COVID-19 case and the development of pneumonia decreased along CFR for patients with and without DM. However, COVID-19 patients with DM were more likely to require intubation when residing at high altitude. Conclusions The study suggests that patients with DM have a higher probability of being a confirmed COVID-19 case and developing pneumonia. Higher altitude had a protective relationship against SARS-CoV-2 infection; however, it may be associated with more severe cases in patients with and without DM. High altitude decreases CFR for all COVID-19 patients. Our work also shows that women are less affected than men regardless of altitude.

BackgroundThe spectrum of pre-existing renal disease is known as a risk factor for severe COVID-19 outcomes. However, little is known about the impact of COVID-19 on patients with diabetic nephropathy in comparison to patients with chronic kidney disease.MethodsWe used the Mexican Open Registry of COVID-19 patients 11 to analyze anonymized records of those who had symptoms related to COVID-19 to analyze the rates of SARS-CoV-2 infection, development of COVID-19 pneumonia, admission, intubation, Intensive Care Unit admission and mortality. Robust Poisson regression was used to relate sex and age to each of the six outcomes and find adjusted prevalences and adjusted prevalence ratios. Also, binomial regression models were performed for those outcomes that had significant results to generate probability plots to perform a fine analysis of the results obtained along age as a continuous variable.ResultsThe adjusted prevalence analysis revealed that that there was a a 87.9% excess probability of developing COVID-19 pneumonia in patients with diabetic nephropathy, a 5% excess probability of being admitted, a 101.7% excess probability of intubation and a 20.8% excess probability of a fatal outcome due to COVID-19 pneumonia in comparison to CKD patients (p< 0.01).ConclusionsPatients with diabetic nephropathy had nearly a twofold rate of COVID-19 pneumonia, a higher probability of admission, a twofold probability of intubation and a higher chance of death once admitted compared to patients with chronic kidney disease alone. Also, both diseases had higher COVID-19 pneumonia rates, intubation rates and case-fatality rates compared to the overall population.

Major depression disorder is a mental issue that has been increasing in the last decade, in consequence, prediction or detection of this mental disorder in early stages is necessary. Artificial intelligence techniques have been developed in order to ease the diagnosis of different illnesses, including depression, using audio-visual information such as voice or video recordings and medical images. This research field is growing, and some organizations and descriptions are required. In the present work, a systematic mapping study was conducted in order to summarize the factors involved in depression detection such as artificial intelligence techniques, source of information, and depression scales.

BackgroundThe impact of influenza and various types of coronaviruses (SARS-CoV and MERS-CoV) on pregnancy has been reported. However, the current pandemic caused by SARS-CoV-2 continues to reveal important data for understanding its behavior in pregnant women.MethodsWe analyzed the records of 326,586 non-pregnant women of reproductive age and 7,444 pregnant women with no other risk factor who also had a SARS-CoV-2 RT-PCR result to estimate adjusted prevalence (aP) and adjusted prevalence ratios (aPR) of COVID-19 and its requirement of hospitalization, intubation, ICU admission and case-fatality rates. Adjustment was done through Poisson regressions for age and altitude of residence and birth. Generalized binomial models were used to generate probability plots to display how each outcome varied across ages and altitudes.ResultsPregnancy was independently associated with a 15% higher probability of COVID-19 (aPR: 1.15), a 116% higher probability of its following admission (aPR: 2.169) and a 127% higher probability of ICU admission (aPR: 2.275). Also, pregnancy was associated with 84.2% higher probability of developing pneumonia (aPR: 1.842) and a 163% higher probability of its following admission (aPR: 2.639). There were no significant differences in COVID-19 case-fatality rates between pregnant and non pregnant women (1.178, 95% CI: 0.68-1.67).ConclusionPregnancy was associated with a higher probability of COVID-19, developing of pneumonia, hospitalization, and ICU admission. Our results also suggest that the risk of COVID-19 and its related outcomes, except for intubation, decrease with altitude.

With almost a third of adults being obese, another third hypertense and almost a tenth affected by diabetes, Latin American countries could see an elevated number of severe COVID-19 outcomes. We used the Open Dataset of Mexican patients with COVID-19 suspicion who had a definite RT-PCR result to develop a statistical model that evaluated the progression of SARS-CoV-2 infection in the population. We included patients of all ages with every risk factor provided by the dataset: asthma, chronic obstructive pulmonary disease, smoking, diabetes, obesity, hypertension, immunodeficiencies, chronic kidney disease, cardiovascular diseases, and pregnancy. The dataset also included an unspecified category for other risk factors that were not specified as a single variable. To avoid excluding potential patients at risk, that category was included in our analysis. Due to the nature of the dataset, the calculation of a standardized comorbidity index was not possible. Therefore, we treated risk factors as a categorical variable with two categories: absence of risk factors and the presence of at least one risk factor in accordance with previous epidemiological reports. Multiple logistic regressions were carried out to associate sex, risk factors, and age as a continuous variable (and the interaction that accounted for increasing diseases with older ages); and SARS-CoV-2 infection as the dependent zero-one binomial variable. Post estimation predictive marginal analysis was performed to generate probability trends along 95% confidence bands. This analysis was repeated several times through the course of the pandemic since the first record provided in their repository (April 12, 2020) to one month after the end of the state of sanitary emergency (the last date analyzed: June 27, 2020). After processing, the last measurement included 464,389 patients.The baseline analysis on April 12 revealed that people 35 years and older with at least one risk factor had a lower risk of SARS-CoV-2 infection in comparison to patients without risk factors (Figure 1). One month before the end of the nationwide state of emergency this age threshold was found at 50 years (May 2, 2020) and it shifted to 65 years on May 30. Two weeks after the end of the public emergency (June 13, 2020) the trends converged at 80 years and one week later (June 27, 2020) every male and female patient with at least one risk factor had a higher risk of SARS-CoV-2 infection compared to people without risk factors. Through the course of the COVID-19 pandemic, all four probability curves shifted upwards as a result of progressive disease spread.In conclusion, we found our model could monitor accurately the probability of SARS-CoV-2 infection in relation to age, sex, and the presence of at least one risk factor. Also, because the model can be applied to any particular political region within Mexico, it could help evaluate the contagion spread in specific vulnerable populations. Further studies are needed to determine the underlying nature of the mechanisms behind such observations.

The monitoring of the structural behaviour of singular buildings and the environmental variables that affect them is an upward trend on a global scale. This paper presents a monitoring project of the building of the Institute of Technology (IT) of the University of Castilla-La Mancha in Cuenca, Spain. Different monitoring actions were carried out, specifically there were installed 27 measuring points of the soil water content (both outside and under the building), 4 clinometers with thermometers, a weather station, and 22 points for topographical levelling, thirteen of which are located on the footings of the building. Although 3 of the clinometers recorded data marked almost entirely by the evolution of the interior temperature, the one located in Module 4 showed a more complex behaviour. In order to determine the possible underlying causes of this behaviour, the footings were grouped according to the evolution of the settlements obtained by differential levelling. For this purpose, a novel clustering technique based on the calculation of the Jeffreys distance has been used instead of other more common dissimilarity measures. The analysis revealed a potential cause of the anomalous behaviour of a group of footings and permitted the study of the influence of temperature and other environmental and operative variables on this behaviour, allowing the detection of anomalies in the future. © 2019 Elsevier Ltd

Background A Demographic and Family Health Survey (ENDES, for Encuesta Demografica y de Salud Familiar in Spanish) is carried out annually in Peru. Based on it, the anemia prevalence was 43.6% in 2016 and 43.8% in 2017 using the WHO cutoff value of 11 g/dL and the altitude-correction equation. Objective To assess factors contributing to anemia and to determine its prevalence in Peruvian children 6 to 35 months old. Methods We used the MEASURE DHS-based ENDES survey to obtain representative data for11364 children from 6 to 35 months old on hemoglobin and health determinants. To evaluate normal hemoglobin levels, we used the original WHO criterion of the 5th percentile in children without chronic malnutrition and then applied it to the overall population. Relationships between hemoglobin and altitude levels, usage of cleaning methods to sanitize water safe to drink, usage of solid fuels and poverty status were tested using methodology for complex survey data. Percentile curves were made for altitude intervals by plotting hemoglobin compared to age. The new anemia rates are presented in graphs by Peruvian political regions according to the degree of public health significance. Results Hemoglobin increased as age and altitude of residence increased. Using the 5th percentile, anemia prevalence was 7.3% in 2016 and 2017. Children from low altitudes had higher anemia prevalence (8.5%) than those from high altitudes (1.2%, p

Objective To standardize clinical evaluation of patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) using a checklist. Methods Qualitative study that included: (1) nominal group (18 experts); (2) literature reviews of measures used in the assessment of patients with axial SpA or PsA; and (3) focus groups, one with rheumatologists and another with patients, organized to become familiar with their opinion on medical assistance. Taking this into account, the experts selected the measures to be included in the checklist based on their relevance, feasibility, and the outcome type. Results The checklist includes measures for the evaluation of personal history, physical examination, activity and function, laboratory tests, imaging studies and treatments. It also defines risk factors of radiographic progression, predictors of the response to biological therapies, and comprises measures of excellence. Conclusions This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis.

Resumen Objetivo Estandarizar la evaluacion clinica de pacientes con espondiloartritis (EspA) axial y artritis psoriasica (APs). Metodos Estudio cualitativo que incluyo: 1) grupo nominal (18 expertos); 2) revision de la literatura sobre variables empleadas en la evaluacion de los pacientes con EspA axial o APs, y 3) grupo focal con reumatologos y otro con pacientes con EspA axial o APs para analizar la evaluacion de las EspA en las consultas de reumatologia. Los expertos seleccionaron las variables a incluir en el cuadro de actuacion con base en su relevancia, factibilidad en consulta y metodo/s de medicion. Resultados El cuadro de actuacion incluye las variables para valorar antecedentes personales, exploracion fisica, actividad y funcion, pruebas complementarias y tratamientos. Detalla factores de riesgo de progresion radiografica, factores predictores de respuesta a terapia biologica, e incluye variables de excelencia. Conclusiones Este cuadro de actuacion para pacientes con EspA axial y APs podra ayudar a homogeneizar la practica clinica diaria y a mejorar el manejo y el pronostico de estos pacientes.

Over 3 billion people use solid fuels as a means of energy and heating source, and ~ 50% of households burn them in inefficient, poorly ventilated stoves. In 2010, ~ 43% of the 640 million preschool children in 220 countries suffered from a certain degree of anemia, with iron deficiency as the main cause in developed countries whereas its causes remained multifactorial in the undeveloped group. In this study, we explore the relations of country-wide variables that might affect the people's health status (from socioeconomic status to more specific variables such as water access). We found independent relationship between solid fuel use and anemia in children under five years old (p < 0.0001), taking into account the prevalence of anemia in pregnant woman and the access to improved water sources. Countries in which the population uses solid fuel the most have over three times higher anemia rates in children than countries with the lowest prevalence of solid fuels use. There is still a complex relationship between solid fuels use and anemia, as reflected in its worldwide significance (p < 0.05) controlled for measles immunization, tobacco consumption, anemia in pregnant mothers, girl's primary education, life expectancy and improved water access but not (p > 0.05) when weighing for sanitation access or income per capita.

Background Currently, there is no formally accepted pharmacological treatment for COVID-19. Materials and methods We included COVID-19 outpatients of a Peruvian primary care center from Lima, Peru, who were treated between April 30 - September 30, 2020, with hydroxychloroquine and azithromycin. Logistic regression was applied to determine factors associated with case-fatality rate. Results A total of 1265 COVID-19 patients with an average age of 44.5 years were studied. Women represented 50.1% of patients, with an overall 5.9 symptom days, SpO2 97%, temperature of 37.3 °C, 41% with at least one comorbidity and 96.1% one symptom or sign. No patient treated within the first 72 h of illness died. The factors associated with higher case fatality rate were age (OR = 1.06; 95% CI 1.01–1.11, p = 0.021), SpO2 (OR = 0.87; 95% CI 0.79–0.96, p = 0.005) and treatment onset (OR = 1.16; 95% CI 1.06–1.27, p = 0.002), being the latter the only associated in the multivariate analysis (OR = 1.18; 95% CI 1.05–1.32, p = 0.005). 0.6% of our patients died. Conclusions The case fatality rate in COVID-19 outpatients treated with hydroxychloroquine/azithromycin was associated with the number of days of illness on which treatment was started.

Objective To validate oral exfoliative cytology in the analysis of the microRNA expression profile in oral lichenoid disease (OLD). Study Design The expression of 13 microRNAs was analyzed in 26 cases, 16 diagnosed as OLD and 10 controls with no oral mucosal pathology. Cytologic samples from the oral mucosa obtained using an Orcellex toothbrush were analyzed using reverse transcription-quantitative polymerase chain reaction and TaqMan microRNA assays. Results The aberrant expression was validated for 2 microRNAs (miR-146 a-5 P and miR-7-1-3 P) of those previously recognized in the biopsy study. Conclusion This is the first time that oral exfoliative cytology is validated in a microRNA study in OLD. The microRNAs validated in this study are associated with both inflammatory and carcinogenic phenomena that are involved in the etiopathogenesis of this potentially malignant oral disorder.

In the last few years, the platforms for online learning, such as MOOCs, are becoming more and more popular. Particularly, in fields like computer science, students very often choose this way, instead of official programs, to complete their formation. In this context, universities must adapt to changes in order to offer the kind of formation that is demanded nowadays. In this article we present CiDAEN, and online course in data science and cloud applications that is offered from the University of Castilla-La Mancha (Spain). We describe how it has been implemented in a public university through a non-official program. We also share our (successful) experience, describe the methodology, the tools, and the importance of communication channels in maintain the interest of students.

Tuberculosis (TB) is an infectious granulomatous disease caused by Mycobacterium tuberculosum which typically compromises the lungs, but can also affect other organs (extrapulmonary TB). In the Americas, the extrapulmonary form represents 15% of newly diagnosed cases, matching the global incidence. An adverse genetic background aided by the immunosupression state of these patients increases the risk of presenting the extrapulmonary form involving the lymph glands, pleura, genitourinary tract, bones and joints, meninges, bowel, pericardium, and the skin in order of their frequencies. As such, osteoarticular TB represents only 1–3% of extrapulmonary cases globally. In Peru, extrapulmonary TB represents 17.6% of newly diagnosed cases. The most affected age group comprises people between 20 and 59 years of age (65.45% of diagnoses). In the developing world, infectious diseases (particularly TB) are one of the main causes of morbimortality in systemic lupus erythematosus patients. The authors report the case of a 21-year-old female patient with an systemic lupus erythematosus background who had swelling in her left hand for 6 months prior to admission in which the diagnosis was suspected after histological study.

Background and objective Pneumonia constitutes one of the major causes of worldwide mortality in young children. Poverty has been traditionally assigned as the underlying factor accounting for these trends. However, the independent role of solid fuel use yielding biomass pollution on pneumonia rates among young children has not been extensively examined. Methods Independent socio-economic variables, and the percentage of solid fuel use, tobacco consumption, improved water access source and sanitation facilities were extracted for each country from the available public databases. Multivariate regression analyses were performed to assess potential associations between these recognized risk factors and country pneumonia incidence in young children

The quality of three types of treated sludges (sludge from the paper recycling industry, and sewage sludge treated by composting with pruning waste and thermally dried) was assessed in this work. The amendments were physicochemically characterized and evaluated for their microbiological quality and for contamination with pollutants. All three organic amendments showed an absence of pathogens, so they are microbially suitable for agricultural use. The pollutants studied in the amendments included eight heavy metals and 83 organic compounds. Heavy metals, pesticides, polycyclic aromatic hydrocarbons, octylphenol, bisphenol A, and parabens were found in the organic amendments. The amount and type of contaminants depended on the sample sources and differed between samples from a single origin. The presence of some of the pollutants found has not been previously reported in organic amendments. The germination assay showed that these amendments may be applied to soil in controlled doses. As far as we know, this is the first reported study that has evaluated a great variety of pollutants (heavy metals, pesticides, persistent and emerging organic pollutants) in sludge from the recycled paper industry; moreover, studies in other waste products in which such a broad range of pollutants has been evaluated have been scarce until now due to the complexity of these matrices. © 2016 Taylor & Francis Group, LLC.

Bayesian networks learning is computationally expensive even in the case of sacrificing the optimality of the result. Many methods aim at obtaining quality solutions in affordable times. Most of them are based on local search algorithms, as they allow evaluating candidate networks in a very efficient way, and can be further improved by us ing local search-based metaheuristics to avoid getting stuck in local optima. This approach has been successfully applied in searching for network structures in the space of directed acyclic graphs. Other algorithms search for the networks in the space of equiva lence classes. The most important of these is GES (Greedy Equiv alence Search). It guarantees obtaining the optimal network under certain conditions. However, it can also get stuck in local optima when learning from datasets with limited size. This article proposes the use of local search-based metaheuristics as a way to improve the behaviour of GES in such circumstances. These methods also guar antee asymptotical optimality, and the experiments show that they improve upon the score of the networks obtained with GES.

To improve the professor time management, a study using optical mark recognition has been carried out. A free software package [automultiple choice (AMC)] and low-cost software (GEXCAT) has been tested on the evaluation of several groups of UPM students. This paper is the beginning of a UPM educational innovation project. As a result of the experience, both softwares are analyzed to develop in the future a new GEECA version, including optical mark recognition for classroom evaluations. The updates made to GEECA 2013 are presented and the adaptation of GEECA to work with AMC and GEXCAT.

Using flexible tethering techniques, porcine models of experimental scoliosis have shown scoliotic curves with vertebral wedging but very limited axial rotation. The aim of this experimental work was to induce a severe progressive scoliosis in a growing porcine model for research purposes. A unilateral spinal bent rigid tether was anchored to two ipsilateral pedicle screws in eight pigs. The spinal tether was removed after 8 weeks. Ten weeks later, the animals were sacrificed. Conventional radiographs and 3D CT-scans were taken to evaluate changes in the alignment of the thoracic spine. After the first 8 weeks of rigid tethering, all animals developed scoliotic curves (mean Cobb angle: 24.3°). Once the interpedicular tether was removed, the scoliotic curves progressed in all animals during 10 weeks reaching a mean Cobb angle of 49.9°. The sagittal alignment of the thoracic spine showed loss of physiologic kyphosis (Mean: -18.3°). Axial rotation ranged from 10° to 49° (Mean 25.7°). Release of the spinal tether results in progression of the deformity with the development of proximal and distal compensatory curves. In conclusion, temporary interpedicular tethering at the thoracic spine induces severe scoliotic curves in pigs, with significant wedging and rotation of the vertebral bodies, and true compensatory curves. CLINICAL RELEVANCE The tether release model will be used to evaluate corrective non-fusion technologies in future investigations. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:174-182, 2018.

Lipschutz ulcer is an acute vulvar ulcerative process, considered to belong to the group of aphthous ulcers. It usually occurs in female children or young women. This ulcer is not associated with venereal disease but has been associated with a recent history of the Epstein-Barr virus. The process, which presents as an ulcer flare-ups, is extremely painful and usually responds well to local and systemic steroid therapy. If medical therapy is unsuccessful, surgical treatment is required.

This paper presents a methodology that allows the identification of optimum geosynthetic mitigation designs and the assessment of their cost-effectiveness taking into account the spatial-temporal probability of occurrence of sinkholes of different diameters and the characteristics and mechanical strength of the road. The procedure is illustrated using a specific case study of a road built in a sinkhole-prone area near Zaragoza city, Spain. The most cost-effective geosynthetic distribution is identified integrating in the cost-benefit analyses a sinkhole hazard model that includes an empirical magnitude and frequency relationship. A sensitivity analysis reveals the parameters whose uncertainty has a higher impact on the profitability of the mitigation measure. The impact of the actual temporal and spatial distribution of damaging sinkholes on the cost-effectiveness of the optimum geosynthetic design has been evaluated by means of Monte Carlo simulations. The proposed approach could be applied, with some modifications, to other mitigation measures (e.g. slabs), different structures (e.g. railways), as well as other processes (e.g. landslides, piping).

In recent years, researchers and laboratory support companies have recognized the utility of automated profiling of laboratory mouse activity and behavior in the home-cage. Video-based systems have emerged as a viable solution for non-invasive mouse monitoring. Wider use of vision systems for ethology studies requires the development of scalable hardware seamlessly integrated with vivarium ventilated racks. Compact hardware combined with automated video analysis would greatly impact animal science and animal-based research. Automated vision systems, free of bias and intensive labor, can accurately assess rodent activity (e.g., well-being) and behavior 24-7 during research studies within primary home-cages. Scalable compact hardware designs impose constraints, such as use of fisheye lenses, placing greater burden (e.g., distorted image) on downstream video analysis algorithms. We present novel methods for analysis of video acquired through such specialized hardware. Our algorithms estimate the 3D pose of mouse from monocular images. We present a thorough examination of the algorithm training parameters’ influence on system accuracy. Overall, the methods presented offer novel approaches for accurate activity and behavior estimation practical for large-scale use of vision systems in animal facilities.

A numerical model is presented to simulate the hydro-mechanical behaviour of the porous rocks that form the deep saline aquifers which are currently being considered as potential CO 2 storage reservoirs. The model has taken into account the equations of state regulating the behaviour of CO 2 , in both the supercritical state in which will be injected, and under atmospheric conditions. Whilst the flow model is founded on a “conventional” advective/diffusive formulation, the geomechanical constitutive model used is a critical state model that includes a non-linear hypoelastic law, and a brittle/ductile yield which takes into account mechanical degradation and the effect of partial saturation caused by the CO 2 flow. With this model, it will be possible to analyse the localisation of the deformation which may occur when a dilatant brittle yield is reached, and thus to analyse the role played by the preferential flow paths associated with this localisation. A partial differential equation solver based on the finite element method, which adopts a multiphysics simulation environment, has been used. After some examples of validation, the simulation of a synthetic example that highlights the capacities of the model is presented.

Sinkholes in karst areas disrupt transportation route serviceability causing significant direct and indirect economic losses and may lead to accidents involving fatalities. A quantitative procedure has been developed to identify the most suitable mitigation designs for a road recently built in an area with a very high probability of sinkhole occurrence. Installation of geogrids with different resistances to a variable number of road sections has been simulated taking into account the occurrence probability of sinkholes with different diameters in each section. The proposed methodology includes the following phases: (1) Development of a sinkhole hazard model that predicts the occurrence probability of sinkholes with different diameters in each 5 × 5 m pixel of the road. (2) Vulnerability appraisal of the road by means of stability analyses. (3) Risk assessment for the “without geogrid” and multiple “with geogrid” scenarios including direct and indirect economic losses, as well as expected number of fatalities. (4) Cost–benefit analysis to estimate the net benefit of the mitigation designs. (5) Acceptability analysis considering geogrid solutions based on cost-effectiveness, conventional (maximum acceptable rate of fatalities) and utility-based (maximum acceptable investment in mitigation to prevent fatalities) criteria. (6) Sensitivity analysis to evaluate the impact of the uncertainty of a set of parameters on the most critical results from the risk management perspective. The presented method could be easily adapted to other geohazards (e.g. shallow landslides, rock-falls, piping), different infrastructures (e.g. railways), as well as to other corrective measures (e.g. concrete slabs, catch fences, armoured roofs, steel meshes, barrier systems).

A 51-year-old woman with a personal history of vitiligo, normal thyroid hormone studies, a simple hysterectomy for multiple uterine myomas at age 35 years, and childhood adenotonsillectomy was seen for progressive hearing loss. She reported mild asthenia, cold intolerance, mild dysphagia with frequent choking while eating and drinking, and a progressive increase in inspiratory effort, especially in the supine position. Her partner described a progressively worsening history of snoring and witnessed apneic episodes, mostly in the supine position. Mild to moderate daytime sleepiness was also present.

Objetivo Dada la gran cantidad de informacion actual sobre el uso de terapias biologicas (TB) en la artritis psoriasica (APs), y la variabilidad de la misma en cuanto a su calidad, desde la Sociedad Espanola de Reumatologia (SER) se ha impulsado la generacion de recomendaciones basadas en la mejor evidencia posible. Estas deben de servir de referencia para reumatologos e implicados en el tratamiento de APs que vayan a utilizar o consideren la utilizacion de TB. Metodos Las recomendaciones se emitieron siguiendo la metodologia de grupos nominales y basadas en revisiones sistematicas. El nivel de evidencia y el grado de recomendacion se clasificaron segun el modelo del Center for Evidence Based Medicine de Oxford y el grado de acuerdo se extrajo por tecnica Delphi. Resultados Se realizan recomendaciones sobre el uso de las TB disponibles en la actualidad en nuestro pais para el tratamiento de la APs. Estas recomendaciones incluyen la evaluacion de la enfermedad, objetivos del tratamiento, esquema terapeutico y cambios en el mismo. Conclusiones Se presentan las actualizaciones a las recomendaciones SER para el uso de TB en pacientes con APs

Objective Due to the amount and quality variability regarding the use of biologic therapy (BT) in psoriatic arthritis (PsA) patients, the Spanish Society of Rheumatology (SER) has promoted the generation of recommendations based on the best evidence available. These recommendations should serve as reference to rheumatologists and those involved in the treatment of patients with PsA, who are using, or about to use BT. Methods Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and degree of recommendation was classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Results We have produced recommendations for the use of TB currently available for PsA in our country. These recommendations include disease assessment, treatment objectives, therapeutic scheme and switching. Conclusions We present an update on the SER recommendations for the use of BT in patients with PsA.

This article presents the study conducted and the actions taken to stabilise the foundations of 25 low-rise (two/three-storey) buildings in Alcazar de San Juan (Ciudad Real, central Spain). Owing to the immediate attention required, it was decided that the study would focus on procuring a synthetic model that would be able to provide a satisfactory explanation for the tendency of the movements, overlooking the detailed model of each building. This analysis pointed out that the mobilisation was probably due to both the shrinkage caused by the existing trees during the dry-growing seasons, and to the loss of lateral confinement caused by the excavation of a service trench adjacent to the footings of the buildings. In keeping with this mechanism, stabilization was carried out by transplanting the trees growing near the damaged buildings and installing a line of piles to provide lateral support to the footings. The evolution of the damage was therefore stopped.

Trees growing close to buildings in urban landscapes may change the soil moisture around foundations, producing shrinkage and swelling. This paper presents a numerical solver to estimate the movements resulting from these volumetric strains. This tool will be of assistance in both designing the footings of new buildings and in the analysis of damage associated with buildings that have already been constructed. The conceptual model used is based on current knowledge of the hydro-mechanical behaviour of unsaturated soils. Its numerical implementation is simple, making it easy for users to make changes as they see fit. The program has been verified, validated, and applied in a real stabilization problem.

Pancreatitis is a relatively rare but severe manifestation in systemic lupus erythematosus (SLE) patients. We report a case of a 39-year-old woman with previous SLE diagnose treated with prednisone and mycophenolate mofetil who developed an acute pancreatitis complicated by pancreatic pseudocysts within the context of a severe lupus flare. Elevated serum amylase and computerized tomography confirmed the diagnosis and mechanical obstruction or toxic-metabolic etiologies were ruled out. In the present case, we opted for the clinical surveillance of pancreatic pseudocyst and not perform invasive medical procedures to drainage. A steroid therapy was started in order to achieve SLE and pancreatitis remission, however, it was unable to avoid the development of multiorgan failure and patient died a few days after diagnosis was made.

Electrokinetic processes provide the basis of a range of very interesting techniques for the remediation of polluted soils. These techniques consist of the application of a current field in the soil that develops different transport mechanisms capable of mobilizing several types of pollutants. However, the use of these techniques could generate nondesirable effects related to the geomechanical behavior of the soil, reducing the effectiveness of the processes. In the case of the remediation of polluted soils with plasticity index higher than 35, an excessive shrinkage can be observed in remediation test. For this reason, the continued evaporation that takes place in the sample top can lead to the development of cracks, distorting the electrokinetic transport regime, and consequently, the development of the operation. On the other hand, when analyzing silty soils, in the surroundings of injection surfactant wells, high seepages can be generated that give rise to the development of piping processes. In this article methods are described to allow a reduction, or to even eliminate, both problems., Los procesos electrocinéticos proporcionan la base de una serie de técnicas muy interesantes para la remediación de suelos contaminados. Estas técnicas consisten en la aplicación de un campo actual en el suelo que desarrolla diferentes mecanismos de transporte capaces de movilizar varios tipos de contaminantes. Sin embargo, el uso de estas técnicas podría generar efectos no deseables relacionados con el comportamiento geomecánico del suelo, reduciendo la efectividad de los procesos. En el caso de la remediación de suelos contaminados con índice de plasticidad superior a 35, se puede observar una contracción excesiva en la prueba de remediación. Por este motivo, la evaporación continuada que se produce en la parte superior de la muestra puede provocar el desarrollo de fisuras, distorsionando el régimen de transporte electrocinético y, en consecuencia, el desarrollo de la operación. Por otra parte, al analizar suelos limosos, en el entorno de los pozos de inyección de surfactante, se pueden generar altas filtraciones que dan lugar al desarrollo de procesos de tubería. En este artículo se describen métodos para permitir una reducción, o incluso eliminar, ambos problemas.

Objective.To characterize red eye reactions occurring within 24 hours after receipt of units of leukocyte-reduced red blood cells, determine their etiology, and investigate their potential link to transfusion.Methods.We conducted a survey of transfusion facilities nationwide to determine the scope and magnitude of the reactions; performed case-control and cohort studies among transfused patients at the facility where most reactions occurred; and performed animal experiments, using cellulose acetate derivatives extracted from leukocyte-reduction filters and filter precursors, to reproduce reactions.Results.From January 1, 1997, through January 15, 1998, we identified 159 reactions in 117 patients from 17 states. Reactions were characterized by conjunctival erythema or hemorrhage (in 100% of patients), eye pain (in 62%), photophobia (in 46%), and decreased visual acuity (in 32%). Symptom onset occurred 1-24 hours after initiation of transfusion and resolved within a median of 5 days. Reactions were associated with transfusion sessions that included units of red blood cells filtered with a specific brand of filter, the LeukoNet filter (HemaSure) (odds ratio, 100.4; P< .001). There was a dose-response relationship between the number of LeukoNet-filtered units transfused and the attack rate for reactions, ranging from 0.8% among sessions in which 1 unit was transfused to 27.3% among sessions in which 3 or more units were transfused (P< .001). A similar ocular syndrome was elicited in rabbits injected with cellulose acetate derivatives extracted from unused LeukoNet filters or filter precursors. No reactions were reported after LeukoNet filters were withdrawn from the market.Conclusions.This transfusion-associated red eye syndrome was linked to a specific brand of leukocyte-reduction filter and likely resulted from cellulose acetate derivatives leached from the filter membrane.

Tidal mills were the main industrial activity in the Bay of Cadiz for centuries. They were the last step in the production of salt and flour made by grinding grains. They were installed along the shallow channels, called “caños”, around the Bay, where the frictional and geometrical effects are very strong. The authors have analyzed the propagation of the semidiurnal tidal waves along the Caño de Sancti Petri and the available tidal power in the area. The ancient tidal mills were located where the available tidal potential energy is highest, which ensured productivity for grinding salt and wheat in ancient times. Some considerations about the possibility of installing tidal power plants in the Bay of Cadiz now are given, which show that it could be a real and renewal alternative source of energy for the area. Los molinos de marea fueron durante siglos la actividad industrial más importante de la Bahía de Cádiz. Eran, con la molienda, el último paso de la cadena de producción de la sal y los cereales. Estaban localizados en los canales largos y poco profundos de los alrededores de la Bahía de Cádiz, denominados “caños”. En ellos los efectos de fricción y geométricos tienen gran importancia. Los autores analizan la propagación de las ondas de marea semidiurnas a lo largo del Caño de Sancti Petri y la potencia de marea disponible en él. La localización de los molinos de marea antiguos corresponde a los lugares donde la energía potencial de la marea es máxima, asegurando, en aquel entonces, una alta producción en la molienda de sal y cereal. Se considera la posibilidad de explotar la energía de mareas industrialmente en términos de centrales mareomotrices, siendo una alternativa real como fuente de energía alternativa para la zona.

summary. In 2000, the American Red Cross (ARC) received reports of unusual transfusion reactions of unknown aetiology among patients receiving leucocyte-reduced (LR) red blood cell (RBC) units in multiple distribution regions. We evaluated potential risk factors of reactions among patients who received LR-RBC transfusions. A case–patient was defined as any patient with onset of back pain while receiving an LR-RBC transfusion from 1 January to 25 May 2000. Controls were chosen randomly and selected in a 1:3 case : control ratio from healthcare facilities in which case–patients were transfused. Product-specific risk factors of reactions were further determined through nested case–control study, procedural review of blood collection facility and quality-control-testing record review of product processing. Reaction incidence rates were determined through ARC blood product distribution data by region of blood collection and processing. There were 29 reactions detected in patients who received transfusions in 13 healthcare facilities in five states. Eighteen case–patients and 78 controls were included in the case–control study. In univariate analysis, case–patients were more likely than controls to have a haematologic malignancy, to have received the transfusion as an outpatient, to have received an RBC transfusion within the previous 3 months, to have received medication used to prevent reactions or to diminish their intensity upon transfusion (i.e. premedication) or to have received LR-RBC units prepared with the HemaSure r\LS System™ (HS) rather than two other filters used. In multivariate analysis limited to recipients of HS-filtered RBC units, transfusion premedication [adjusted odds ratio (AOR) = 7; 95% confidence interval (CI) 1·4–37; P = 0·02] and transfusion as an outpatient (AOR = 5; 95% CI 1·1–20; P = 0·03) were independently associated with reactions. The rate of reported transfusion reactions was 2·0 reactions per 10 000 RBC units distributed. A multistate cluster of transfusion reactions was significantly associated with leucocyte filtration of RBC units prepared with a specific product, the HS filter. The reactions also were independently associated with premedication and transfusion as an outpatient; these may be surrogates for an increased risk of reaction or for greater likelihood of detection. The mechanism for these reactions has not been elucidated. This cluster of reactions underscores the importance of surveillance efforts to detect adverse events after transfusion, particularly when new methods to modify blood products are introduced.

Objectives:To determine the cause of an outbreak of Klebsiella pneumoniae bloodstream infections (BSIs) among neonates in a high-risk nursery and to institute control measures.Design:During the on-site investigation, a cohort study to identify risk factors for K. pneumoniae BSI, a point-prevalence study to assess K. pneumoniae colonization, a maternal cohort study to determine maternal K. pneumoniae colonization, and an observational study to evaluate healthcare worker (HCW) compliance with infection control practices were conducted.Patients And Setting:Neonates in a 40-bed high-risk nursery in a 700-bed university hospital in Cali, Colombia.Intervention:Cohorting of neonates colonized with K. pneumoniae.Results:The overall K. pneumoniae BSI attack rate was 10 of 105 (9.5%). In the retrospective cohort study, the number of blood transfusions (OR, 3.1 per transfusion; P = .02; CI95,1.4–9.7) and intravenous injections (OR, 1.2 per injection; P = .04; CI95, 1.0–1.5) were independently associated with K. pneumoniae BSI. The overall prevalence of K. pneumoniae colonization was 61% among neonates and 7% among mothers. During the HCW assessment, suboptimal intravenous therapy practices were observed. A cohorting intervention resulted in a significant reduction in K. pneumoniae colonization (12% vs 61%; RR, 0.19; P < .001). During the intervention period, no K. pneumoniae BSIs occurred.Conclusions:This investigation suggested that the outbreak probably occurred due to widespread colonization and suboptimal infection control and intravenous therapy practices. Cohorting successfully reduced the overall prevalence of K. pneumoniae colonization and, along with improved infection control practices, probably prevented K. pneumoniae BSIs.

To date, only 6 sporadic Microbacterium species (formerly coryneform Centers for Disease Control and Prevention [CDC] groups A-4 and A-5) infections have been reported. The source, mode of transmission, morbidity, mortality, and potential for nosocomial transmission of Microbacterium species remain unknown. From 26 July through 14 August 1997, 8 episodes of coryneform CDC group A-5 symptomatic bacteremia occurred in 6 patients on the oncology ward at the Maine Medical Center. One patient died. All isolates were identified at CDC as Microbacterium species and had identical DNA banding patterns by pulsed-field gel electrophoresis. To assess risk factors for Microbacterium species infection, a retrospective cohort study was conducted. The presence of a central venous catheter was the strongest risk factor (6/6 vs. 22/48; relative risk, 3.2; P

We describe the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance (NNIS) system. Elements of the system critical for successful reduction of nosocomial infection rates include voluntary participation and confidentiality; standard definitions and protocols; identification of populations at high risk; site-specific, risk-adjusted infection rates comparable across institutions; adequate numbers of trained infection control professionals; dissemination of data to health-care providers; and a link between monitored rates and prevention efforts.